Much of the decline in the incidence and fatality rates of infectious diseases is attributable to public health measures—especially immunization, improved sanitation, and better nutrition.
Immunization remains the best means of preventing many infectious diseases. Recommended immunization schedules for children and adolescents can be found online at http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html, and the schedule for adults is at http://www.cdc.gov/vaccines/schedules/hcp/adult.html (see also Chapter 30-13 and 30-14). Substantial morbidity and mortality from vaccine-preventable diseases, such as hepatitis A, hepatitis B, influenza, and pneumococcal infections, continue to occur among adults. Increases in the number of vaccine-preventable diseases in the United States (eg, regional epidemics) highlight the need to understand the association of vaccine refusal and disease epidemiology. Strategies to improve vaccination rates include increasing community demand for vaccinations; enhancing access to vaccination services; provider- or system-based interventions, such as reminder systems; assigning vaccination responsibilities to non-physician personnel; and interventions that activate patients through personal contact.
Evidence suggests annual influenza vaccination is safe and effective with potential benefit in all age groups, and the Advisory Committee on Immunization Practices (ACIP) recommends routine influenza vaccination for all persons aged 6 months and older, including all adults. When vaccine supply is limited, certain groups should be given priority, such as adults 50 years and older, individuals with chronic illness or immunosuppression, and pregnant women. An alternative high-dose inactivated vaccine is available for adults 65 years and older. This inactivated trivalent vaccine contains 60 mcg (rather than 15 mcg as in other strains) of hemagglutinin antigen per influenza vaccine virus strain (Fluzone High-Dose [Sanofi Pasteur]). Adults 65 years and older can receive either the standard-dose or high-dose vaccine, whereas those younger than 65 years should receive a standard-dose preparation.
The ACIP recommends two doses of measles, mumps, and rubella (MMR) vaccine in adults at high risk for exposure and transmission (eg, college students, health care workers). Otherwise, one dose is recommended for adults aged 18 years and older. Physician documentation of disease is not acceptable evidence of MMR immunity.
Routine use of 13-valent pneumococcal conjugate vaccine (PCV13) is recommended among adults aged 65 and older. Individuals 65 years of age or older who have never received a pneumococcal vaccine should first receive PCV13 followed by a dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) 6–12 months later. Individuals who have received more than one dose of PPSV23 should receive a dose of PCV13 more than 1 year after the last dose of PPSV23 was administered.
Increasing reports of pertussis among US adolescents, adults, and their infant contacts have stimulated vaccine development for older age groups. The ACIP recommends routine use of a single dose of tetanus, diphtheria, and 5-component acellular pertussis vaccine (Tdap) for adults aged 19–64 years to replace the next booster dose of tetanus and diphtheria toxoids vaccine (Td). Due to increasing reports of pertussis in the United States, clinicians may choose to give Tdap to persons aged ...